<div id="main-form">
	<ul class="main-two-cols patient-details-el">
		<li class="two-cols-left">
			<p>
				<?php 
					$fullname 	 = $patient_row['lname'].", ".$patient_row['fname'].", ".$patient_row['mname']."."; 
					$dateofbirth = date("M j, Y", strtotime($patient_row['birthday']));
					$phoneNo	 = $patient_row['phone_'.$patient_row['preferred_contact']]." (".$patient_row['preferred_contact'].")";
					$ageStr		 = computeAge($patient_row['birthday']) ." yrs old";
				?>
				<input type="text" name="name" value="<?=$fullname?>" style="width:210px;" disabled />
				<input type="text" name="dob" value="DOB: <?=$dateofbirth?>" style="width:100px;" disabled />
				<input type="text" name="age" value="<?=$ageStr?>" style="width:79px;" disabled />
			</p>
			<p>
				<input type="text" name="address" value="<?=$patient_row['address1']?>" style="width:275px;" disabled>
				<input type="text" name="phone" value="<?=$phoneNo?>" style="width:117px;" disabled>
			</p>
			<ul class="rows">
				<li class="leftcol">Allergies:</li>
				<li class="rightcol">
					<input type="text" name="name" id="name" value="<?=$patient_row['name']?>">
				</li>
			</ul>
			<ul class="rows">
				<li class="leftcol">Warnings:</li>
				<li class="rightcol">
					<input type="text" name="name" id="name" value="<?=$patient_row['name']?>">
				</li>
			</ul>
		</li>
		
		<li class="two-cols-right">
			<p>
				<span>Occupation :</span> <input type="text" name="name" value="<?=$patient_row['name']?>" style="width:195px;" disabled />
				<input type="text" name="name" value="<?=$patient_row['name']?>" style="width:60px;" disabled />
			</p>
			<p>
				<span>Record No. :</span> &nbsp;<input type="text" name="name" value="<?=$patient_row['record_no']?>" style="width:95px;" disabled />
				&nbsp;&nbsp;
				<span>ATSI :</span> &nbsp;&nbsp;&nbsp;<input type="text" name="name" value="<?=$patient_row['name']?>" style="width:110px;" disabled />
			</p>
			<p>
				<span>Pension No.:</span> <input type="text" name="name" value="<?=$patient_row['pension_no']?>" style="width:95px;" disabled />
				&nbsp;&nbsp;
				<span>IHI No. :</span> <input type="text" name="name" value="<?=$patient_row['ihi_no']?>" style="width:110px;" disabled />
			</p>
			<p>
				<span>Smoking Hx:</span>&nbsp;<input type="text" name="name" value="<?=$patient_row['name']?>" style="width:95px;" disabled />
				&nbsp;&nbsp;
				<span>PCEHR :</span> <input type="text" name="name" value="<?=$patient_row['name']?>" style="width:108px;" disabled />
			</p>
		</li>
	</ul>

	<div id="tabs" class="patient-tabs">
		<ul>
			<li><a href="#tabs-1"><span class="old-script"></span> Old Scripts</a></li>
			<li><a href="#tabs-2"><span class="imm"></span> Imm</a></li>
			<li><a href="#tabs-3"><span class="correspondence"></span> Correspondence</a></li>
			<li><a href="#tabs-4"><span class="md-exchange"></span> MD Exchange</a></li>
			<li><a href="#tabs-5"><span class="summary"></span> Summary</a></li>
			<li><a href="#tabs-6"><span class="current-rx"></span> Current Rx</a></li>
			<li><a href="#tabs-7"><span class="progress1"></span> Progress</a></li>
			<li><a href="#tabs-8"><span class="past-history"></span> Past History</a></li>
			<li><a href="#tabs-9"><span class="results"></span> Results</a></li>
			<li><a href="#tabs-10"><span class="letters"></span> Letters</a></li>
			<li><a href="#tabs-11"><span class="documents"></span> Documents</a></li>
		</ul>

		<div id="tabs-1">
			<div id="coming-soon">
				<h1>Coming Soon! Development on going...</h1>
				<p>This feature is temporarily unavailable. Sorry for the inconvenience.</p>
			</div>
		</div>
		<div id="tabs-2">
			<div id="coming-soon">
				<h1>Coming Soon! Development on going...</h1>
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			</div>
		</div>
		<div id="tabs-3">
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			</div>
		</div>
		<div id="tabs-4">
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			</div>
		</div>
		<div id="tabs-5">
			<div id="coming-soon">
				<h1>Coming Soon! Development on going...</h1>
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			</div>
		</div>
		<div id="tabs-6">
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			</div>
		</div>
		<div id="tabs-7">
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			</div>
		</div>
		<div id="tabs-8">
			<div id="coming-soon">
				<h1>Coming Soon! Development on going...</h1>
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			</div>
		</div>
		<div id="tabs-9">
			<div id="coming-soon">
				<h1>Coming Soon! Development on going...</h1>
				<p>This feature is temporarily unavailable. Sorry for the inconvenience.</p>
			</div>
		</div>
		<div id="tabs-10">
			<div id="coming-soon">
				<h1>Coming Soon! Development on going...</h1>
				<p>This feature is temporarily unavailable. Sorry for the inconvenience.</p>
			</div>
		</div>
		<div id="tabs-11">
			<div id="coming-soon">
				<h1>Coming Soon! Development on going...</h1>
				<p>This feature is temporarily unavailable. Sorry for the inconvenience.</p>
			</div>
		</div>

	</div>
</div>